Returning home broken not the norm for U.S. veterans

Two decades of research by Rumi Kato Price, PhD, professor of psychiatry at the Washington University School of Medicine, shows reason for optimism about the future of returning soldiers.

“The notion that our soldiers deployed to conflict regions come back ‘broken’ is a one-sided story in the media. There are both potential positive and negative effects of war experiences,” says Price, whose research has explored trauma, post-traumatic stress disorder (PTSD), substance abuse and suicide among American military service members and veterans.

Price’s ongoing research on National Guard members indicates a positive experience of deployment. ­Further, stories of veterans and service members include an element of “post-traumatic growth,” an idea that people can grow in positive ways from traumatic experiences. Those who do suffer from war trauma and health issues are less likely to be stigmatized than previous era veterans since the military’s recognition of PTSD as a medical problem. Yet only 40 percent of service members and veterans who present mental-health problems seek treatment. And some of those who do seek treatment may have a long wait for their claims to be processed, making it ­difficult to receive timely assistance.

These delays could contribute to rising suicide rates among military service members (now at 23 per 100,000 in the Army), which have steadily increased since 2002. War combat may be a contributor to this rise, but experts disagree about its impact. A report published in The ­Journal of the American Medical Association and ­other studies point to mental illness, substance abuse, and relationship and financial problems as possible causative factors for military service ­members, as in the civilian population.

One way to prevent suicide among ­service members, Price advocates, is to implement “means restriction.” At least for those who ­communicate their suicidal thoughts after ­deployment, some ­measures to restrict their ­access to firearms could be ­developed, and research in a foreign country has shown a measurable impact.

With regard to substance abuse, there has been little evidence of increased illicit drug use among U.S. troops ­inside Afghanistan and other conflict regions, unlike during the Vietnam War, when soldiers returned home with opiate-addiction problems. ­Prescription-drug abuse, though, has tripled to 11 percent among service members, ­according to one recent military survey. And, ­according to Price, other substance abuse — especially excessive alcohol use — often begins when service members get home and find it difficult to reintegrate into civilian life.

The Vietnam Era Study, jointly funded by the National Institute on Drug Abuse (NIDA) and the National Institute of Mental Health, followed a cohort of Vietnam Veterans to examine the long-term effects of war exposure, substance abuse, psychiatric disorders, and life events. This original epidemiologic study led to a clinical follow-up effort because of the results among the cohort showing excessive risk of suicide and suicidal behaviors.

Price also is a principal investigator on a U.S. Department of Defense grant designed to explore the effects on National Guard service members and their families.Known as “The Family as a Total Package” (FAMPAC) study, the research is being conducted by Washington University researchers in the School of Medicine’s Department of Psychiatry and the Brown School’s Center for Violence and Injury Prevention (CVIP).

The FAMPAC study examines behavioral health and reintegration issues from the perspective of a family system. National Guard and Reserve service members are distinct from the regular active-component military because they generally complete military training only one weekend a month, have regular civilian jobs, and live in the community the rest of the time.

However, the federal government may deploy them for active duty overseas for national defense or peacekeeping missions. After their deployment (traditionally for one year), the service members must then reintegrate into home life with their family and into their civilian lives and jobs.

The Family as a Total Package has two objectives: First, it seeks to evaluate whether the Yellow Ribbon Reintegration Program, a public health style education program, will have short- and long-term positive impacts on service members and their families. The study also examines the effects of deployment and war trauma on service members and families during their period of reintegration back to normal life in the U.S.

Through secondary prevention efforts focused on mental and behavioral health, Price and her team hope that suicide rates will also be impacted.

“Our belief is that addressing a wider array of mental health consequences of deployment and war trauma will actually reduce the frequency and intensity of suicidal thoughts,” says Price in a 2012 CVIP newsletter storyabout the FAMPAC project.

“Working with Drs. Melissa Jonson-Reid, Monica Matthieu, and William True, we were able to include measures on childhood maltreatment, so that we can examine the lasting effect of childhood trauma on mental health and reintegration many years after *service members+ complete the deployment cycle.”

The team has also found that family members, mostly spouses, have experienced a considerable level of childhood trauma and negative events. Their level of posttraumatic stress disorder and depression symptoms are not all that different from those of returning service members.

After 20 years of examining the psychiatric consequences of a variety of traumas and environmental factors, Price hopes to integrate various pathological consequences of trauma experiences into the concept of “trauma spectrum disorder.”

Along with her research, Price now directs a NIDA institutional pre- and post-doctoral training program in Washington University’s Department of Psychiatry. Stemming from her own positive experiences with mentors starting with a first grade teacher who reached out to her after she experienced the trauma of a devastating typhoon, Dr. Price has a passion for mentoring and supporting other promising academics.

The opportunities for fostering cross-disciplinary biomedical and behavioral/social research are Price’s favorite parts of her involvement with CVIP. “Even with the best intentions, we are just too busy with our own research and teaching tasks to be able to collaborate across campuses to produce really meaningful results. Suicide prevention, childhood maltreatment and abuse, suicide attempts and adult violent behaviors have real- life consequences too severe for us not to be engaged in a range of research and prevention activities.”